Schlaganfall-assoziierte Pneumonie – Prophylaxe und Therapie einer schwerwiegenden Komplikation

Die Prognose des Schlaganfalls hängt nicht nur von der Schwere des Infarktes sondern maßgeblich auch von häufigen Komplikationen ab. Deren Verhinderung stellt ein zentrales Behandlungsziel des Schlaganfalls dar. Neben erhöhtem Hirndruck zählen Pneumonien zu den schwerwiegendsten Komplikationen der Akutphase. Aspiration als Folge von Dysphagie ist zwar ein bedeutender Grund für die hohe Pneumonierate, experimentelle wie klinische Daten zeigen aber, dass eine veränderte Immunantwort das Auftreten von Schlaganfall-assoziierten bakteriellen Infektionen entscheidend fördert. Trotz umfangreicher Präventionsmaßnahmen, besonders zur Verhinderung von Aspiration, konnte die Pneumonierate bisher nicht ausreichend gesenkt werden. Mithilfe von Pneumonie-Scores und Immunmarkern können Hochrisikopatienten für Schlaganfall-assoziierte Pneumonien identifiziert werden. Die pharmakologische Prävention mittels Antibiose oder Immunmodulation sind mögliche neue Therapieansätze. Für die Praxis bleibt eine frühzeitige antibiotische Behandlung bei Verdacht auf eine Pneumonie oder Harnwegsinfektion der aktuelle Standard.

Stroke-outcome is mainly influenced by severity of infarction and frequently occurring complications. Avoiding them is one of the main goals of stroke treatment. Pneumonia and increased intracranial pressure are the most severe complications during the acute phase. Aspiration as a result of dysphagia is an important cause of pneumonia, but does not explain sufficiently its high incidence after stroke. Experimental and clinical data demonstrate, that an impaired immune response after stroke favors bacterial infections. Even though great improvements have been made preventing aspiration in stroke-patients, pneumonia rate could not be reduced sufficiently. Pneumonia scores and laboratory parameters measuring immune competence allow identifying patients at high risk for pneumonia. Pharmacologial prevention such as preventive antibacterial or immune-modulating treatment are promising approaches for better outcome. Most importantly, antibiotic treatment should be initiated immediately upon a suspected infection.

Key words

Stroke-associated pneumonia - infection - prevention - immunodepression - preventive antibiotic therapy

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